I am pretty squeamish around blood (even reading about it...), but this piece was so well written and engrossing and impactful that I made it all the way through in one shot. I had no idea that the bovie instrument (and broadly the entire field of electrosurgery [1]) was even a thing; I assumed it was anll still scalpels and such.
An incredible piece highlighting something people should know more about; thanks for posting this!
I too am squeamish and while I agree that the piece was very well written, it was too much for me. I had to tap out during the part about 18th/19th century grafting experiments. Just too much for me lol.
Will probably pick this back up and skip over the rest of that part though!
Surgeons had long learned sewing skills from their mothers, sisters, and wives. But in 1901, surgical trainee Alexis Carrel’s mother sent him to someone more gifted, Marie-Ann Leroudier, embroideress of Paris’s high society
I'm curious how important agility with hands are for modern surgeons compared to anatomy and medical knowledge in general. What makes a "great surgeon" today?
It's still super important. Surgeons endlessly practice abstruse knots and take out high-value insurance policies against losing hands or fingers or manual dexterity.
Source: surgeons in my family and wider sphere of acquaintance.
"Abstruse knotting techniques" would probably be more a more accurate phrase. I've listened in on two surgeons discuss at great length and in detail the merits of which knot and access path to use for, say, tying off a vein one-handed, by feel, when it's located somewhere behind another organ. The decision is complicated, so far as I was able to understand the conversation, by the patient's current blood volume and rate of loss.
Why not take out a policy against not being able to practice your profession? Wouldn't they be in a bad spot if they lost their eyesight, but kept their dexterity?
I dunno. That's probably what it is - but I've more generally heard it expressed as "my hands are insured for [$x million]". One friend would say that as a pure status brag, and my uncle to explain why he wouldn't play basketball with the rest of the family.
I visited a surgical museum once (somewhere in Scotland IIRC). They hade a mock "robotic assisted" sewing setup. Basically you look into a microscope and have to use two manipulator arms to tie a knot. I've never struggled so much with such a seemingly simple task, the amount of concentration and fingerspitzengefühl required was more than I could muster. It was a real eye opener to surgical skill.
This is a very long and well written article. One fact I'd like to highlight is that the liver can regrow to the same size quite quickly if you choose to be a living liver donor.
This may be true, but you will now have a single lobe of your liver instead of the two lobes that most people have. Your ability to survive a liver injury will be diminished for that reason.
Further, unless things have changed I believe you will also lose your gallbladder as a result of donating a liver lobe.
As a living liver donor myself, I think it is not exactly the same size, it is more like the functionally healthy state and the liver remains a bit smaller than the original size AFAIK.
Well I had my lungs collapsed after the surgery as my diaphragm or chest wall---I don't know which---was accidentally punctured, but was mostly okay except for that. It took me about 5--6 months to fully recover, including the aforementioned lung collapse. It was 2008 so such accidents are presumably rarer nowadays.
A good article, although I question why the author is talking about Iran and its organ market, if she's never been there and doesn't talk to anyone about it. Probably more complicated - and obviously exploitive, I mean, it's Iran - than she leads us to believe. Since it's Hacker News, cue the:
- "I'm outraged that death is brain death [or something else from the medical establishment] and not [some other crank folk definition]"
- "We should be able to pay for livers!" has never considered that he or his extended family could have been poor enough to be exploited by such a world
- "There's no organ exploitation in Asia" despite donation rates being so low and transplants being so high, the organs must be coming from somewhere
- "All transplant is exploitative" he says, until he or a family member needs a life-saving organ donation
I don't see how being compensated for giving your organ to someone else is worse than being told you can either give it away for free or not at all.
Imagine if billionaires had to pay the "riff-raff" organ donors to continue living their vain and hollow lives instead of bribing hospitals and public officials to cut in line. If I were old and on my way out the door, this would give me a chance to leave something behind for my wife and kids.
Let's say I have a heart condition or neurodegenerative disease and I'm living on borrowed time. I could make at least a couple hundred thousand selling 1 lobe out of my very healthy liver to a desperate billionaire. Knowing my heart or brain will give out long before my liver, I can accept my fate and die with courage and dignity and as an added bonus, also help my family by profiteering off of the cowardice and selfishness of people like Larry Ellison or Jeff Bezos.
The part everyone leaves out is that the entire operation will contribute to the estates of every participant but one: the person who grew the organ. And, in fact, you will find that median donor estate is far lower than that of every other participant: the nurses, the OPO employees, the surgical team. They have the rarest part. They get nothing. And they’re poorer.
Matthew 25:29 comes to mind
> For to everyone who has will more be given, and he will have an abundance. But from the one who has not, even what he has will be taken away.
This is a good point. The author discusses how in Iran, you can sell a kidney, Netherlands provides financial resources to live donors, and how Israel incentivizes donations by increasing the priory of family members of organ donors.
It’s voluntary, and many of us are happy to contribute our livers if we are in the unlikely scenario of being in a vegetative state so that it can help a recipient. I don’t think the recipients estate is financially enriched by the procedure- in fact the opposite. I’m no Christian but isn’t that something Jesus would do? He’d give his earthy body obviously, and certainly not for financial incentive.
A liver transplant kept someone close to me alive for a few more years, enough years to luckily and unexpectedly have a child, who is our magic child. Modern medicine is unbelievable. We live in extraordinary times.
> Sir Roy Yorke Calne FRS FRCS (30 December 1930 – 6 January 2024) was a British surgeon and pioneer in organ transplantation. He was part of the team that performed the first liver transplantation operation in Europe in 1968, the world's first liver, heart and lung transplantation in 1987, the first intestinal transplant in the UK in 1992 and the first successful combined stomach, intestine, pancreas, liver and kidney cluster transplantation in 1994.
Excellent article. However, I do feel it is missing a more macabre side of the organ donation market in the US, especially around premature death categorization, in the below case, using "donation after circulatory death" instead of brain dead.
> There are two models for giving organs. The first, common in Europe, relies on “presumed consent.” Unless you explicitly opt out, your healthy organs belong to society, and you need special permission to be buried with them.
I am pretty squeamish around blood (even reading about it...), but this piece was so well written and engrossing and impactful that I made it all the way through in one shot. I had no idea that the bovie instrument (and broadly the entire field of electrosurgery [1]) was even a thing; I assumed it was anll still scalpels and such.
An incredible piece highlighting something people should know more about; thanks for posting this!
[1] https://en.wikipedia.org/wiki/Electrosurgery
Relevant recent HN discussion on "Electricity can heal wounds three times as fast (2023)" [0]
[0]: https://news.ycombinator.com/item?id=45604779
I too am squeamish and while I agree that the piece was very well written, it was too much for me. I had to tap out during the part about 18th/19th century grafting experiments. Just too much for me lol.
Will probably pick this back up and skip over the rest of that part though!
This is extraordinarily well written. Deep without being verbose. I thought I’d just peek at the link but it sucked me in.
Extraordinarily indeed.
I’d love to know what makes this such an easy read. This is good writing to learn from.
Surgeons had long learned sewing skills from their mothers, sisters, and wives. But in 1901, surgical trainee Alexis Carrel’s mother sent him to someone more gifted, Marie-Ann Leroudier, embroideress of Paris’s high society
I'm curious how important agility with hands are for modern surgeons compared to anatomy and medical knowledge in general. What makes a "great surgeon" today?
It's still super important. Surgeons endlessly practice abstruse knots and take out high-value insurance policies against losing hands or fingers or manual dexterity.
Source: surgeons in my family and wider sphere of acquaintance.
Abstruse? Difficult to understand? Isn't is mostly just extra wraps on a square knot?
Now, difficult to tie I'll grant: fingers and string both covered in blood and possibly fatty residue, time crunch, limited access...
"Abstruse knotting techniques" would probably be more a more accurate phrase. I've listened in on two surgeons discuss at great length and in detail the merits of which knot and access path to use for, say, tying off a vein one-handed, by feel, when it's located somewhere behind another organ. The decision is complicated, so far as I was able to understand the conversation, by the patient's current blood volume and rate of loss.
Tie that kidney off for me would you please nurse, my date is waiting for me. Two bowlines and a sheepshank should suffice.
Why not take out a policy against not being able to practice your profession? Wouldn't they be in a bad spot if they lost their eyesight, but kept their dexterity?
I dunno. That's probably what it is - but I've more generally heard it expressed as "my hands are insured for [$x million]". One friend would say that as a pure status brag, and my uncle to explain why he wouldn't play basketball with the rest of the family.
I visited a surgical museum once (somewhere in Scotland IIRC). They hade a mock "robotic assisted" sewing setup. Basically you look into a microscope and have to use two manipulator arms to tie a knot. I've never struggled so much with such a seemingly simple task, the amount of concentration and fingerspitzengefühl required was more than I could muster. It was a real eye opener to surgical skill.
Ahhhh fingerspitzengefühl, I forgot about that one. Thank you for reminding me, I need to start using it more.
https://en.wikipedia.org/wiki/Fingerspitzengef%C3%BChl
Sounds like the Surgeons Hall Museum in Edinburgh. I saw the same display there in 2018.
This is a very long and well written article. One fact I'd like to highlight is that the liver can regrow to the same size quite quickly if you choose to be a living liver donor.
This may be true, but you will now have a single lobe of your liver instead of the two lobes that most people have. Your ability to survive a liver injury will be diminished for that reason.
Further, unless things have changed I believe you will also lose your gallbladder as a result of donating a liver lobe.
As a living liver donor myself, I think it is not exactly the same size, it is more like the functionally healthy state and the liver remains a bit smaller than the original size AFAIK.
Do you experience any side effects from the donation?
Well I had my lungs collapsed after the surgery as my diaphragm or chest wall---I don't know which---was accidentally punctured, but was mostly okay except for that. It took me about 5--6 months to fully recover, including the aforementioned lung collapse. It was 2008 so such accidents are presumably rarer nowadays.
Upvoting for your heroism.
Great respect.
A good article, although I question why the author is talking about Iran and its organ market, if she's never been there and doesn't talk to anyone about it. Probably more complicated - and obviously exploitive, I mean, it's Iran - than she leads us to believe. Since it's Hacker News, cue the:
- "I'm outraged that death is brain death [or something else from the medical establishment] and not [some other crank folk definition]"
- "We should be able to pay for livers!" has never considered that he or his extended family could have been poor enough to be exploited by such a world
- "There's no organ exploitation in Asia" despite donation rates being so low and transplants being so high, the organs must be coming from somewhere
- "All transplant is exploitative" he says, until he or a family member needs a life-saving organ donation
I don't see how being compensated for giving your organ to someone else is worse than being told you can either give it away for free or not at all.
Imagine if billionaires had to pay the "riff-raff" organ donors to continue living their vain and hollow lives instead of bribing hospitals and public officials to cut in line. If I were old and on my way out the door, this would give me a chance to leave something behind for my wife and kids.
Let's say I have a heart condition or neurodegenerative disease and I'm living on borrowed time. I could make at least a couple hundred thousand selling 1 lobe out of my very healthy liver to a desperate billionaire. Knowing my heart or brain will give out long before my liver, I can accept my fate and die with courage and dignity and as an added bonus, also help my family by profiteering off of the cowardice and selfishness of people like Larry Ellison or Jeff Bezos.
This piece is absolutely a strong candidate for David Brooks' Sidney Awards. Thank you for sharing it.
The part everyone leaves out is that the entire operation will contribute to the estates of every participant but one: the person who grew the organ. And, in fact, you will find that median donor estate is far lower than that of every other participant: the nurses, the OPO employees, the surgical team. They have the rarest part. They get nothing. And they’re poorer.
Matthew 25:29 comes to mind
> For to everyone who has will more be given, and he will have an abundance. But from the one who has not, even what he has will be taken away.
This is a good point. The author discusses how in Iran, you can sell a kidney, Netherlands provides financial resources to live donors, and how Israel incentivizes donations by increasing the priory of family members of organ donors.
It’s voluntary, and many of us are happy to contribute our livers if we are in the unlikely scenario of being in a vegetative state so that it can help a recipient. I don’t think the recipients estate is financially enriched by the procedure- in fact the opposite. I’m no Christian but isn’t that something Jesus would do? He’d give his earthy body obviously, and certainly not for financial incentive.
This aspect is not left out of the article.
A liver transplant kept someone close to me alive for a few more years, enough years to luckily and unexpectedly have a child, who is our magic child. Modern medicine is unbelievable. We live in extraordinary times.
I can't avoid feeling admiration for each and every person involved in such a procedure.
And the most impressive thing I managed today is to test out a data and schema replication utility...
I'd just like to mention Roy Calne, transplant pioneer, humanist, skeptic. Only died last year, at 93.
https://en.wikipedia.org/wiki/Roy_Calne
> Sir Roy Yorke Calne FRS FRCS (30 December 1930 – 6 January 2024) was a British surgeon and pioneer in organ transplantation. He was part of the team that performed the first liver transplantation operation in Europe in 1968, the world's first liver, heart and lung transplantation in 1987, the first intestinal transplant in the UK in 1992 and the first successful combined stomach, intestine, pancreas, liver and kidney cluster transplantation in 1994.
Is there a reason why vents and respirators are always mixed up by laymen?
Excellent article. However, I do feel it is missing a more macabre side of the organ donation market in the US, especially around premature death categorization, in the below case, using "donation after circulatory death" instead of brain dead.
https://archive.is/Qq3Qw
> There are two models for giving organs. The first, common in Europe, relies on “presumed consent.” Unless you explicitly opt out, your healthy organs belong to society, and you need special permission to be buried with them.
What? Not that i'm aware of.
starts disinfecting the garage
Alternatively[0]:
MRS. BROWN: 'Ere. What's going on?
MAN: Uh, he's donating his liver, madam.
MR. BROWN: [screaming]
MRS. BROWN: Is this because he took out one of those silly cards?
[0] http://www.montypython.50webs.com/scripts/Meaning_of_Life/9....